E/C is justified in suspending PTD benefits for failure to complete DWC-19

Yesterday, I wrote about how an E/C must present evidence that a Claimant failed to complete an earnings report (DWC-19 form) in order to suspend temporary partial benefits.  In the Rucker v. Just Brakes case, the E/C failed to assert this as an affirmative defense and therefore the Judge could not limit Claimant’s right to penalties and interest nor was the E/C correct in suspending benefits.

In other words: Send them the forms. Send them the forms. Send them the forms.  (See yesterday’s post!)

But, what about permanent total disability? Can an E/C unilaterally suspend PTD benefits when a Claimant fails to complete a DWC-19 form?

 

E/C’s must assert affirmative defense that Claimant fails to complete DWC-19’s

Repeat after me: Send them the forms.  Send them the forms.  Send them the forms!!!

What forms, you ask?  Why the DWC-19 forms, of course!  DWC-19 forms are the wage loss forms that Claimants must complete (under penalty of perjury) indicating to the Carrier that she is not earning any wages or less than 80% of her AWW and is entitled to temporary partial benefits.

An E/C does not have to pay TPD benefits until it receives the completed DWC-19’s forms from the Claimant.  However. . . alot of E/C’s forget to send Claimant the forms.

Let this case be a lesson . . .

 

Changes to Adjuster Code of Ethics

The Association of Workers’ Compensation Proffesionals (WCCP) has a very important post up on their website about potential draconian changes to the Department of Financial Services’ Adjuster Code of Ethics.  Some of these changes do not reflect the real world scenario of a W/C adjuster.

These changes have the potential to expose alot of Carriers and their claims professionals to serious legal exposure.  I encourage you to read the letter, posted by WCCP Executive Director Jim Greer, here.   There is still time to communicate your dissatification with these changes to the Department of Financial Services.

If you are a claims professional and have not joined WCCP, I encourage you to do so.  They provide excellent services, including industry newso, nline forums, job listings, and continuing education programs, including one of my favorites, the Florida Bar Workers’ Compensation Board Certification Forum held in Orlando every April.   The WCCP is kind enough to link to this blog as well. 

You can see my updated posts at their website and Facebook page.

 

Claimant must have knowledge of return to work status for appropraite denial of TTD benefits

The phrase “ignorance of the law is no excuse” is applicable to all areas of jurisprudence.  But not Florida Workers’ Compensation law.  Here, we embrace ignorance of the law to an art form. 

For many Claimants, the process of receiving medical treatment is a confusing one.  Even though it is required of them, many physicians do not inform Claimants of their work status.  For Employer/Carriers this can be very frustrating since we are responsible for paying disability benefits based on the opinions of the authorized doctors.  Unfortunately for E/C’s, if a Claimant thinks that their doctor has them off work and that is not the case, but the doctor has failed to notify Claimant, the E/C still must pay.

In this case, ignorance is bliss.

 

Exclusion of witnesses by the Judge is a “drastic remedy”

When both Claimants and E/C’s are forced to litigate their disputes on the “rocket docket”–or 210 days from the date of Petition to trial–there has to be mutual cooperation between the parties to accommodate discovery.  If there can be no cooperation, for whatever reason, it is the Judge of Compensation Claims duty to weigh the interests of a quick resolution versus due process.

In a recent case, the First DCA leaned towards due process, allowing a Claimant to present a doctor’s testimony whose deposition may have (or not) violated a discovery order.

 

If an E/C ignores a referral request to a specialist, it forfeits right to contest medical necessity

I know personally that many adjusters are both overworked and underpaid.  But, it is still important to be aware of the medical benefit “deadlines” that the W/C statute imposes on E/C’s.

A Carrier that fails to comply with these deadlines forfeits its ability to contest requested medical treatment, even if that treatment is not medically necessary.